人类免疫缺陷病毒/获得性免疫缺陷综合征患者慢性腹泻1例报告。

Sheetal Panjaria, Prasan Kumar Panda
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引用次数: 0

摘要

背景:人类免疫缺陷病毒(PLHIV)/获得性免疫缺陷综合征患者的慢性腹泻是一个诊断挑战,通常由机会性感染(OIs)、恶性肿瘤或疾病本身进展引起。我们报告了一例晚期人类免疫缺陷病毒(HIV)患者慢性腹泻,体重明显减轻,抗逆转录病毒治疗(ART)不依从性,突出了HIV消耗综合征,OIs和恶性肿瘤之间的诊断困境。病例总结:一名36岁女性,5年前通过家庭筛查被诊断为艾滋病毒,出现3个月的大量水样腹泻,伴有腹痛和体重减轻(14公斤,3个月减轻30%)。她不接受抗逆转录病毒治疗。没有近期旅行史、食物污染史或结核病接触史。发烧是轻微和短暂的。体格检查显示面色苍白,双足水肿,无淋巴结病变或器官肿大。生殖器检查无明显异常。常规检查显示严重贫血,并确认为艾滋病毒感染者。CD4计数< 36 cells/µL。对可能的隐孢子虫病开始了硝唑昔尼特的经验治疗。排除OIs后,重新启动ART。经治疗,她的腹泻消失,并能耐受口服。给予营养支持,出院时病情稳定,给予抗逆转录病毒治疗、预防性抗生素治疗,并接受进一步评估的随访指导。结论:在抗逆转录病毒治疗无效的PLHIV伴慢性腹泻患者中,区分HIV耗损综合征、OIs(隐孢子虫、鸟分枝杆菌复合体、巨细胞病毒结肠炎)和恶性肿瘤(非霍奇金淋巴瘤和肛门癌)至关重要。CD4逐渐下降、全身性炎症和营养不良有利于进行性艾滋病毒/获得性免疫缺陷综合征,而不是急性成骨不全或恶性肿瘤。早期识别和管理,包括重新开始抗逆转录病毒治疗和营养支持,对预后至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Chronic diarrhoea in a human immunodeficiency virus/acquired immunodeficiency syndrome patient: A case report.

Background: Chronic diarrhoea in people living with human immunodeficiency virus (PLHIV)/acquired immunodeficiency syndrome presents a diagnostic challenge, often resulting from opportunistic infections (OIs), malignancies, or disease progression itself. We present a case of an advanced human immunodeficiency virus (HIV) patient with chronic diarrhoea, significant weight loss, and antiretroviral therapy (ART) non-compliance, highlighting the diagnostic dilemma between HIV wasting syndrome, OIs, and malignancy.

Case summary: A 36-year-old female, diagnosed with HIV five years ago on family screening, presented with three months of profuse watery diarrhoea, associated with crampy abdominal pain and weight loss (14 kg, 30% in 3 months). She was non-compliant with ART. There was no history of recent travel, food contamination, or tuberculosis contact. Fever episodes were mild and transient. Physical examination revealed pallor and bilateral pedal oedema without lymphadenopathy or organomegaly. Genital examination was unremarkable. Routine investigations revealed severe anaemia and confirmed PLHIV status. CD4 count was < 36 cells/µL. Empirical treatment with nitazoxanide was initiated for possible cryptosporidiosis. After ruling out OIs, ART was restarted. With treatment, her diarrhoea resolved, and she tolerated oral intake. Nutritional support was provided, and she was discharged in stable condition with ART, prophylactic antibiotics, and follow-up instructions for further evaluation.

Conclusion: In ART-noncompliant PLHIV with chronic diarrhoea, distinguishing between HIV wasting syndrome, OIs (Cryptosporidium, Mycobacterium avium complex, cytomegalovirus colitis) and malignancies (non-Hodgkin lymphoma and anal carcinoma) are critical. Gradual CD4 decline, systemic inflammation, and malnutrition favour progressive HIV/acquired immunodeficiency syndrome rather than an acute OI or malignancy. Early recognition and management, including ART reinitiation and nutritional support, are crucial for prognosis.

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